Pulmonary hypertension associated with bronchopulmonary dysplasia in preterm infants.

Autor: Bui CB; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia., Pang MA; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia., Sehgal A; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Monash Newborn, Monash Health, Clayton, Victoria, Australia., Theda C; The Royal Women's Hospital, Melbourne, Victoria, Australia., Lao JC; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia., Berger PJ; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia., Nold MF; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Monash Newborn, Monash Health, Clayton, Victoria, Australia., Nold-Petry CA; Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia. Electronic address: claudia.nold@hudson.org.au.
Jazyk: angličtina
Zdroj: Journal of reproductive immunology [J Reprod Immunol] 2017 Nov; Vol. 124, pp. 21-29. Date of Electronic Publication: 2017 Oct 02.
DOI: 10.1016/j.jri.2017.09.013
Abstrakt: Bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension (BPD-PH) are chronic inflammatory cardiopulmonary diseases with devastating short- and long-term consequences for infants born prematurely. The immature lungs of preterm infants are ill-prepared to achieve sufficient gas exchange, thus usually necessitating immediate commencement of respiratory support and oxygen supplementation. These therapies are life-saving, but they exacerbate the tissue damage that is inevitably inflicted on a preterm lung forced to perform gas exchange. Together, air-breathing and necessary therapeutic interventions disrupt normal lung development by aggravating pulmonary inflammation and vascular remodelling, thus frequently precipitating BPD and PH via an incompletely understood pathogenic cascade. BPD and BPD-PH share common risk factors, such as low gestational age at birth, fetal growth restriction and perinatal maternal inflammation; however, these risk factors are not unique to BPD or BPD-PH. Occurring in 17-24% of BPD patients, BPD-PH substantially worsens the morbidity and mortality attributable to BPD alone, thus darkening their outlook; for example, BPD-PH entails a mortality of up to 50%. The absence of a safe and effective therapy for BPD and BPD-PH renders neonatal cardiopulmonary disease an area of urgent unmet medical need. Besides the need to develop new therapeutic strategies, a major challenge for clinicians is the lack of a reliable method for identifying babies at risk of developing BPD and BPD-PH. In addition to discussing current knowledge on pathophysiology, diagnosis and treatment of BPD-PH, we highlight emerging biomarkers that could enable clinicians to predict disease-risk and also optimise treatment of BPD-PH in our tiniest patients.
(Copyright © 2017 Hudson Institute of Medical Research. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: